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Joint hypermobility and rectal evacuatory dysfunction: an etiological link in abnormal connective tissue?
S D Mohammed1, P J Lunniss, N Zarate
1GI Physiology Unit (Academic Surgical Unit) and Neurogastroenterology Group, Centre for Digestive Diseases, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK. s.d.mohammed@qmul.ac.uk
Neurogastroenterology and Motility
|July 13, 2010
Summary
Joint hypermobility (JHM) is more common in patients with rectal evacuatory dysfunction (RED). JHM is linked to increased constipation and pelvic floor abnormalities in RED patients.
Area of Science:
- Gastroenterology
- Pelvic Floor Disorders
- Connective Tissue Diseases
Background:
- Pelvic organ prolapse is associated with joint hypermobility (JHM), a feature of connective tissue (CT) disorders.
- The link between JHM and rectal evacuatory dysfunction (RED) has not been previously investigated.
Purpose of the Study:
- To determine the prevalence of JHM in individuals with RED symptoms.
- To compare JHM prevalence in RED patients versus the general population.
Main Methods:
- 273 patients with RED completed bowel symptom and Rome III questionnaires.
- Evacuation proctography and a validated JHM questionnaire were administered to patients and 100 controls.
Main Results:
- 32% of RED patients exhibited JHM, compared to 14% of controls (P=0.0005).
- JHM patients reported higher constipation scores, abdominal pain, need for manual assistance, and laxative use.
- 86% of JHM patients showed significant morphological abnormalities on proctography versus 64% of non-JHM patients (P=0.001).
Conclusions:
- JHM is more prevalent in patients experiencing RED.
- Higher rates of morphological abnormalities in JHM patients suggest a CT-related etiology in RED.
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